© 2007 Tunstall Group Ltd 1 Telehealth, its uses in COPD, the Sheffield experience Sue Thackray - Deputy Head of Development Nursing Sheffield Primary

© 2007 Tunstall Group Ltd 1

Telehealth, its uses in COPD, the Sheffield experience Sue Thackray - Deputy Head of Development Nursing Sheffield Primary Care Trust

Dawn Weston - Lead Development Nurse Respiratory Conditions Sheffield Primary Care Trust

Mike Worden – Telehealth consultant


Terminology

• Telehealth is an umbrella term used to describe the delivery of health related services and information via telecommunications technologies

• As simple as two health professionals discussing a case over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between providers at facilities in two countries.

• 3 main types of telehealth technology– Store and forward telehealth (digital images, video, audio and clinical

data are captured and stored)– Real time telehealth (telecommunications link between the involved

parties allows a real-time interaction)– Remote Monitoring Telehealth (sensors are used to capture and

transmit biometric data, real time or store and forward)


Telehealth for Sheffield Focus: Tunstall telehealth technology focuses on consistent, reliable, and accurate remote monitoring of a patient’s vital signs through the use of simple easy to use equipment that professionals can customise to each patient, enabling day to day individual care according to need.

The most popular (number of monitors in daily use) telehealth monitor in the UK and the World


Sheffield design for telehealth

Genesis monitorsPatient homes Clinicians based

in the Community

Free phone telephone number

Respiratory team Northern General


• Heart Rate

• Blood Pressure

• Weight

• Oxygen Saturation (Sp O2)

• Temperature

• Prothrombin time

• Peak flow (FEV-1)

• Electrocardiogram (ECG)

• Blood Glucose

• Customisable subjective questions most suitable to the individual in care i.e. Have you used your oxygen in the last 24 hours?

A large number of vital signs

can be remotely monitored


Monitor Functionality

• Up to 4 programmed sessions per day for patients• Any number of manual tests • real time monitoring function • Once prompted a patient has 30 minutes to engage the

monitor giving the patient time to settle before collecting vitals

• Remote programming ability – flexibility to the patients routine

• Multi user ability • Languages include: English, French, French Canadian,

Spanish, Italian, German, Polish, Russian, Armenian, Portuguese, Hindi and Welsh


Sheffield design for telehealth

Genesis monitorsPatient homes Clinicians based

in the Community

Free phone telephone number

Respiratory team Northern General


Triage software


Full patient history


1 to 90 day graphic and tabular trendReports

Fax, email, print to clinical staff


Liase with clinical staff and distribute

relevant data

2

Agree SLA’s and key

stakeholders

1

Discharge patientremove equipment

and clean2

Define policy and procedure

1

Trouble shoot

2

Patient recruitment,

Referral process & consent

2

Admit patient

2

Home assessment &

installs

2

Daily triage,notifying staff of medical

exceptions

2

Define roles & responsibilities

1

Project Cycle

Primary Care

Se

co

nd

ary

ca

re

Social Services/monitoring centre

Ca

rers

Evaluation 1 & 2

Review &options for mainstream

1

Key

1 = telehealth steering group responsibilities

2 = implementation group

responsibilities


COPD and telehealth - Service Redesign

• Shift in focus to Primary Care - a Transition from ‘hospital care’ to ‘out-of-hospital care’– Bringing care closer to home– Delivering more services in the community and specifically moving them out of hospital – Innovation and potentially promoting a new service for PBC– Increasing diversity of Primary Care provision– Potential to better manage a patients condition from home

• Admission avoidance– Frequent flyers– Re-admissions & admission prevention– Supported early discharge – Promoting self-care– Efficiency gains

• D39, Chronic Obstructive Pulmonary Disease or Bronchitis w cc (with complication) £2360 per episode

• D40, Chronic Obstructive Pulmonary Disease or Bronchitis w/o cc (without complication) £1752 per episode

• Opportunity to Unbundle PbR tariff– The service supports directly the Government agenda to unbundle the Payment by Results (PbR)

Tariff


Frees up hospital beds18 weeks target

Closer management of chronic disease

Prevent Emergency Admissions

Patient at home where they prefer to be

COST AVOIDANCE

Reassurance and confidence

INDEPENDENCE &DIGNITY

DISEASE & CASE MANAGEMENT!

Quick intervention if condition deteriorates

Opportunity to unbundle PbR tariff

Reduce total referrals into the Acute Sector

Earlier diagnosis and treatment

Choice and controlReduce risk of MRSA and

Clostridium difficile (c-diff) Maximise efficient use

of the primary care budget


What will make a pilot a success?

Innovative PBC Group & PCT Pioneering approach to LTC

management Partnership approach across all

Healthcare professionals Drive, determination, focus and

commitment to make it happen Enthusiasm from all Patients come “First” About patient centred care and

not the equipment


Objectives for the presentation

• Where are we now – Innovation in practice

• How we got there – Sharing experience

• Where are we going – The future


Introduction - the Sheffield focus

• Here to day to discuss our pilot of telehealth and how it has become part of our innovative working practice in COPD

• Sheffield Focus - Industrial legacy - High prevalence of COPD 3% overall - key target areas 6 –7%- Annual rate of COPD unscheduled care admissions 2,000- Average unscheduled care admissions for COPD 166 per month

• Recent developments to build a network of respiratory knowledge in the community to create accessible and responsive services

• Delivery of care through segmented targeted approach • Evidence based care


COPD Unscheduled care admissions to secondary care Source Sheffield PCT 2007

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What we found in our pilot of telehealth

Sheffield PCT ran a 6 month pilot of telehealth:

– Completed Mar 07– Key findings published in HSJ (online)– 80% reduction in home visiting– 50% of patients would have been readmitted without

the support provided by remote monitoring – telehealth

= Significant cost savings


Where are we now – innovation in practice

• Partnership working between Sheffield Primary Care Respiratory Team and the Northern General Hospital NHS Trust Sheffield COPD team

• Led by Sheffield Primary Care Public Health Directorate

• Nurse led

• Developing roles across communities of practice district nurses, new respiratory community nurses – hospital and home


Key benefits we found to the organisation

• Reduction in unscheduled care admissions to STH

• Reduction in number of home visits

• Early identification of patients at risk of hospital admission

• Reduction in travel costs per month

• Prioritisation of clinicians work schedules

• System can be used across hospital and community interface

• Ability for early diagnosis – e.g. hypoxia, rapid heart failure access into support services – e.g. hypoxia patients for oxygen assessment


Benefits to the patient

• Choice for the patient hospital or home

• Tool for self care – Expert patient

• Reduction in anxiety and increase in confidence for the patient and carer’s – unexpected benefits!

• Well received by patients

• No cost for the patient


What did we learn

• Easy to use and install• Increase job satisfaction, reduced stress

levels• Confidence growing in remote monitoring• Developing triage skills• Over coming barriers to change• More confidence in dealing with the more

complex patient


How we implemented and developed telehealth

• Initial trial – pilot of the technology – How it worked for us locally – Identified our target area of patients – Clear patient selection criteria – Identified champion clinicians – Developed strong clinical commitment – Started small to grow big

• Clear plan of where we wanted to go with telehealth – Integration into community COPD pathway– Demonstrate cost benefits– Strong relationships between primary and Secondary care

• Competence frameworks– Official training to support the use of the technology, some staff initially

hesitant


• Fully integrated into the community• Monitoring as integral part of the COPD care pathway• Implemented across all long term conditions• Communication with GP practices and other systems

e.g. System one (TPP), out of hour services• Evaluation via Sheffield University and Sheffield PCT

commencing December 2007 key pilot evaluation to support a larger RCT research study

The Future

The future


The Sheffield Team

• Ruth Marrison Sheffield Teaching Hospitals COPD Co-ordinator

• Cheryl Oates COPD Nurse Specialist COPD Team Sheffield Teaching Hospitals

• Rosemary Lawson Head of Service Redesign Formerly Sheffield PCT

• Dawn Weston Lead Development Nurse Respiratory Care Sheffield PCT

• Sue Thackray Deputy Head of Development Nursing Sheffield PCT

• Lis Reid Head of Developmental Nursing Sheffield PCT

• Nicky Kenyon Head of Clinical Care Pathways Sheffield PCT

• IT Departments Sheffield Teaching Hospitals & Sheffield PCT

• John Skinner Audit and Evaluation Department Sheffield PCT

• Mike Worden Telehealth Consultant Tunstall


“The definition of insanity is doing the same thing over and

over again and expecting a different result.”

~ Albert Einstein

Documents

© 2007 Tunstall Group Ltd 1 Telehealth, its uses in COPD, the Sheffield experience Sue Thackray - Deputy Head of Development Nursing Sheffield Primary